Care pathway for fetal joint contractures, Fetal Akinesia Deformation Sequence and Arthrogryposis Multiplex Congenita.

Introduction The majority of arthrogryposis multiplex congenita (AMC) and lethal forms of AMC such as fetal akinesia deformation sequence (FADS) cases are missed prenatally. We have demonstrated the additional value of fetal motor assessment and evaluation in a multidisciplinary team for the period 2007-2016. An applied care pathway for fetuses presenting with joint contracture(s) in one anatomic region (e.g. talipes equinovares), more than one body part with non-progressive contractures and motility (AMC) and with deterioration over time (FADS). Methods The multidisciplinary team of Amsterdam University Medical Centre Expertise Centre FADS and AMC developed the care pathway. Additional tools are provided including a motor assessment by ultrasound examination and postmortem assessment form. Results An eight-step care pathway is presented with a proposed timing for prenatal sonographic examination, genetic examinations, multidisciplinary meetings, prenatal and postnatal counselling of the parents by specialist also treating after birth, follow-up of prenatal and postnatal findings with counselling for future pregnancies. Discussion/conclusion The scheduled serial structural and motor sonograpahic assessment together with follow-up examinations and genetic analysis, should be tailored per prenatal centre per available resources. The multidisciplinary care pathway may pave the way to increase detection rate and diagnosis of isolated contracture(s), talipes equinovares with underlying genetic causes and the rare phenotypes AMC/FADS and prompt treatment after birth within expertise teams.

Applications of Pose Estimation in Human Health and Performance across the Lifespan

The emergence of pose estimation algorithms represents a potential paradigm shift in the study and assessment of human movement. Human pose estimation algorithms leverage advances in computer vision to track human movement automatically from simple videos recorded using common household devices with relatively low-cost cameras (e.g., smartphones, tablets, laptop computers). In our view, these technologies offer clear and exciting potential to make measurement of human movement substantially more accessible; for example, a clinician could perform a quantitative motor assessment directly in a patient’s home, a researcher without access to expensive motion capture equipment could analyze movement kinematics using a smartphone video, and a coach could evaluate player performance with video recordings directly from the field. In this review, we combine expertise and perspectives from physical therapy, speech-language pathology, movement science, and engineering to provide insight into applications of pose estimation in human health and performance. We focus specifically on applications in areas of human development, performance optimization, injury prevention, and motor assessment of persons with neurologic damage or disease. We review relevant literature, share interdisciplinary viewpoints on future applications of these technologies to improve human health and performance, and discuss perceived limitations.

The Effect of Oral Motor Therapy on Feeding Difficulties and Eating Behaviors in Younger ASD Children

Background: A variety of feeding difficulties like aversion of food, food selectivity, complete food refusal are the most common problems reported by the Parents of ASD children. Every parent of ASD children struggles to manage their child’s feeding routine as well as undesirable mealtime behaviours, which can cause parental concern and poor family dynamics. Aim: 1) The aim of this study is to analyze the effect of dedicated oral motor work in children with ASD who presented with feeding difficulty. 2) To determine parental concerns related to feeding behavior shown by their child and assess whether an additional home program in parallel with oral motor work by an Occupational Therapist would provide any benefits. Methods: This is a pre and post study where a total number of 18 ASD children at the age of 2-4 year old were participated and selected through BPFAS, out of which 15 copies were considered to be concerned with the oral motor and feeding difficulties of the child. Therefore, 15 participants who were facing feeding difficulties with their children were recruited. Concerned Participants were further assessed by Occupational therapist with the help of ‘The com deall Oro-motor assessment scale for toddlers’. Results: According to The Com Deall Oral-motor assessment scale, some changes observed in the oral motor skills and When parental concern is considered via home plan including mealtime strategies with oral motor activities, the post intervention result showed decrease in Total problem score as well as in Total frequency score. Conclusion: The study concluded that continuous structured direct oral motor work as well as addressing parental concerns via home programs is helpful for the ASD children and gives better understanding of feeding difficulties to their parents. Also, some changes have been seen in oral motor skills through continuous practice of oral motor activities by the therapist.

Profile and early prediction of neuromotor outcome of very low birth weight infants

Background: Very low birth weight infants are at increased risk of developmental disorder. Early identification is necessary for planning and implementation of early intervention. Aims and Objective: To test the association of neurological examination at 40 weeks and 3 months with neuro motor outcome of VLBW infants at 24 months and to identify the perinatal and neonatal risk factors for atypical neurological outcome. Materials and Methods: It is a prospective cohort study. Consecutive 120 VLBW infants were enrolled in a single centre level III neonatal unit of a teaching hospital. Neuro motor assessment was done by Dubowitz neurological examination at 40 weeks and by Hammersmith infant neurological examination (HINE) at 3 months and 12 months at neurodevelopmental clinic. Motor assessment were performed by Alberta Infant Motor Scale (AIMS) at 6 and 12 months and by Bayley Scale of Infant & Toddler scale, (BSID) 3rd edition at 6,12 and 24 months respectively. All assessment ages were corrected for prematurity. Results: At 12 months 4.5% infants developed abnormal tone and 5.6% had motor delay. Four infants developed cerebral palsy at 24 months. Shock in neonatal period had significant association with suboptimal motor outcome at 12 months. Suboptimal HINE score at 12 months was rightly predicted at 3 months by HINE. Conclusion: Early anticipation and early identification of abnormal neuro motor outcome of VLBW infants can be used as simple and cost-effective measures for preventing long term neuro motor morbidity at resource limited countries.

Real-World Evidence for a Smartwatch-Based Parkinson’s Motor Assessment App for Patients Undergoing Therapy Changes

<b><i>Introduction:</i></b> Parkinson’s disease (PD) is poorly quantified by patients outside the clinic, and paper diaries have problems with subjective descriptions and bias. Wearable sensor platforms; however, can accurately quantify symptoms such as tremor, dyskinesia, and bradykinesia. Commercially available smartwatches are equipped with accelerometers and gyroscopes that can measure motion for objective evaluation. We sought to evaluate the clinical utility of a prescription smartwatch-based monitoring system for PD utilizing periodic task-based motor assessment. <b><i>Methods:</i></b> Sixteen patients with PD used a smartphone- and smartwatch-based monitoring system to objectively assess motor symptoms for 1 week prior to instituting a doctor recommended change in therapy and for 4 weeks after the change. After 5 weeks the participants returned to the clinic to discuss their results with their doctor, who made therapy recommendations based on the reports and his clinical judgment. Symptom scores were synchronized with the medication diary and the temporal effects of therapy on weekly and hourly timescales were calculated. <b><i>Results:</i></b> Thirteen participants successfully completed the study and averaged 4.9 assessments per day for 3 days per week during the study. The doctor instructed 8 participants to continue their new regimens and 5 to revert to their previous regimens. The smartwatch-based assessments successfully captured intraday fluctuations and short- and long-term responses to therapies, including detecting significant improvements (<i>p</i> &#x3c; 0.05) in at least one symptom in 7 participants. <b><i>Conclusions:</i></b> The smartwatch-based app successfully captured temporal trends in symptom scores following application of new therapy on hourly, daily, and weekly timescales. These results suggest that validated smartwatch-based PD monitoring can provide clinically relevant information and may reduce the need for traditional office visits for therapy adjustment.

Multiple Linear Regression in Predicting Motor Assessment Scale of Stroke Patients

The Multiple Linear Regression (MLR) is a predictive model that was commonly used to predict the clinical score of stroke patients. However, the performance of the predictive model slightly depends on the method of feature selection on the data as input predictor to the model. Therefore, appropriate feature selection method needs to be investigated in order to give an optimum performance of the prediction. This paper aims (i) to develop predictive model for Motor Assessment Scale (MAS) prediction of stroke patients, (ii) to establish relationship between kinematic variables and MAS score using a predictive model, (iii) to evaluate the prediction performance of a predictive model based on root mean squared error (RMSE) and coefficient of determination R2. Three types of feature selection methods involve in this study which are the combination of all kinematic variables, the combination of the best four or less kinematic variables, and the combination of kinematic variables based on p < 0.05. The prediction performance of MLR model between two assessment devices (iRest and ReHAD) has been compared. As the result, MLR model for ReHAD with the combination of kinematic variables that has p < 0.05 as input predictor has the best performance with Draw I (RMSEte = 1.9228, R2 = 0.8623), Draw Diamond (RMSEte = 2.6136, R2 = 0.7477), and Draw Circle (RMSEte = 2.1756, R2 = 0.8268). These finding suggest that the relationship between kinematic variables and MAS score of stoke patients is strong, and the MLR model with feature selection of kinematic variables that has p < 0.05 is able to predict the MAS score of stroke patients using the kinematic variables extracted from the assessment device.

Motor performance evaluation of newborns with gastroschisis after surgical correction

Introduction: Gastroschisis is a congenital malformation that has risk factors for delayed neuropsychomotor development. That is why it is important to recognize early developmental changes in these newborns during hospitalization in the Neonatal Intensive Care Unit. Objective: To evaluate the motor performance of newborns with gastroschisis after surgical correction. Methods: An observational and retrospective study was carried out with newborns with gastroschisis, assessed by the Test of Infant Motor Performance at the Neonatal Intensive Care Center 2 of the Instituto da Criança e do Adolescente. The test allows the classification of the risk for developmental delay in 4 categories: within the average for age, low average, below average, and well below average. Maternal, neonatal, surgical, and motor assessment data were collected through electronic medical records. Results: Motor assessment was performed on 17 newborns, where 88.23% were classified as “below average” for age. The mean maternal age was 20 years, and the average gestational age and birth weight were 36.38 weeks and 2343.9 grams, respectively, with the majority being female. Simple gastroschisis accounted for 64.71%, and primary closure was possible in 82.35%. The average hospital stay of 53.24 days, and sepsis was the most frequent complication (64.71%). Conclusion: Newborns with gastroschisis remain hospitalized for a long time and are susceptible to complications. It was possible to identify the delay in the development of these newborns early during hospitalization, which allows intervention by physiotherapy before the delay worsens.

Predicting Bottle-Feeding Performance Using a Reorganized Neonatal Oral–Motor Assessment Scale

Date Presented 04/23/21 The Neonatal Oral–Motor Assessment Scale is a clinical tool commonly used to evaluate the oral–motor skills of neonates. This study is to examine its predictability in feeding performance using newly organized items. The results showed that in addition to the adjusted age and weight at observed feed, jaw depression and jaw initiation were the significant predictors for successful bottle feed. Discuss implications of findings and the need for standardized assessment in neonates' feeding. Primary Author and Speaker: Tsu-Hsin Howe Additional Authors and Speakers: Christine L. Kroll